EP1973470B1 - Système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placé sous assistance ventilatoire mécanique - Google Patents

Système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placé sous assistance ventilatoire mécanique Download PDF

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EP1973470B1
EP1973470B1 EP07701707.7A EP07701707A EP1973470B1 EP 1973470 B1 EP1973470 B1 EP 1973470B1 EP 07701707 A EP07701707 A EP 07701707A EP 1973470 B1 EP1973470 B1 EP 1973470B1
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level
respiratory
patient
ventilatory assist
eadi
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German (de)
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EP1973470A4 (fr
EP1973470A1 (fr
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Christer Sinderby
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Maquet Critical Care AB
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Maquet Critical Care AB
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A61M16/026—Control means therefor including calculation means, e.g. using a processor specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0015—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
    • A61M2016/0018—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
    • A61M2016/0021—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with a proportional output signal, e.g. from a thermistor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A61M2016/0033—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
    • A61M2016/0036—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the breathing tube and used in both inspiratory and expiratory phase
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/10—Trunk
    • A61M2210/1014—Diaphragm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/08—Other bio-electrical signals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics
    • A61M2230/42—Rate

Definitions

  • the present invention relates to mechanical ventilatory assist. More specifically, but not exclusively, the present invention is concerned with a system for determining dynamically respiratory features in spontaneously breathing patients receiving mechanical ventilatory assist.
  • the ventilatory assist level should be high enough to ensure that adequate ventilation can take place, however, one should avoid too high levels of ventilatory assist since this may result in disuse atrophy of the inspiratory muscles. There are currently no methods available to monitor and ensure that ventilatory assist levels are adequate.
  • ventilatory assist is uniquely synchronized to patient effort and the mechanical ventilator could be considered as an additional artificial inspiratory breathing muscle under the influence of the brain's respiratory centers and neural respiratory feedback systems. Given the neural integration of such a system, it is not possible to set the assist or ventilation to too high values.
  • a ventilator In unhealthy lungs, some air sacs may collapse, meaning that in those collapsed sacs, gas cannot enter or leave them, thus preventing gas exchange through the collapsed air sacs; in this case, a ventilator will supply a higher concentration of oxygen in order to provide proper blood oxygenation. Also, a ventilator can supply positive end-expirtory pressure (PEEP) to recruit or maintain airways open.
  • PEEP positive end-expirtory pressure
  • the collapsed air sacs During the inflation process of the lungs, by increasing the transpulmonary pressure P TR , the collapsed air sacs will start to open up. When the collapsed air sacs start to open up, they are said to be recruited and the pressure at which the recruitment happens is called the critical opening pressure. However, continuing to increase the transpulmonary pressure P TR will lead to overinflation, which can be dangerous for the patient since it may cause lesions in the lung tissues, which will lead to air leakage out of the lung.
  • underinflation may also cause problems, such as atelectasis, when the recruited air sacs are de-recruited at a pressure threshold referred to as the critical closing pressure. Therefore, proper pressure provided by the mechanical ventilator should fall inside the thresholds of overinflation and underinflation pressures.
  • a method and apparatus for controlling the ventilation pressure are disclosed. By increasing incrementally the pressure, the lung volume is measured and then compared to a previous volume measure. If the increase in the lung volume is higher than 20% when compared to the past value, then the critical opening pressure has been reached.
  • the ventilatory apparatus will stop increasing the pressure.
  • the pressure in the lungs is decrementally decreased and, at each decremental decrease, the lung volume is measured and then compared to the previous value. If a change in the volume of more than 20% is observed, then it means that the critical closing pressure has been reached. And the mechanical ventilatory assist machine stops decreasing the pressure. This method presents the drawback of depending on very slow inflations to measure a static pressure.
  • Patent Application EP 1 295 620 A1 published on March 26, 2003, by J. Björn , and entitled "A Method for Examining Pulmonary Mechanics and a Breathing Apparatus System"
  • a method and apparatus for examining the pulmonary mechanics in a respiratory system is disclosed. More specifically, the apparatus determines a flow, volume and pressure of the gas streaming through the respiratory system. Furthermore, the apparatus compares the measured/determined flow, volume and pressure with reference values set by an operator and then produces an error signal for adjusting accordingly the apparatus. This method depends on oscillations in patients who are not breathing spontaneously.
  • Patent Application EP 1 204 439 A1 published on May 15, 2002, by C. Sinderby , and entitled "Target Drive Ventilation Gain Controller and Method”
  • This device first detects a signal representative of a respiratory drive, then compares this signal to a target drive and finally adjusts the gain of a controller of a lung ventilator in order to control the lung ventilator in relation to the respiratory drive.
  • a method of controlling inspiratory proportional pressure assist ventilation requires no knowledge of the mechanics of the lung, such as its elastance and resistance.
  • An object of the present invention is therefore to provide a method and device for determining dynamically respiratory features in spontaneously breathing patients receiving mechanical ventilatory assist.
  • Document EP-A-1 103 279 describes a lung ventilator device where ventilation to a patient is provided in response to patient effort. This document describes detecting a pressure gradient based on a measured pressure in a continuous manner, which in turn teaches determining the respiratory feature upon any change of the pressure gradient however this document does not teach detection of a change of gradient.
  • Document WO 2005/077268 A describes a method and device for determining a level of ventilatory assist to a ventilator dependent patient.
  • the method comprises calculating a critical threshold of a respiration-related feature, for use in determining a level of ventilatory assist to a patient while preventing fatigue in the patient's respiratory muscle.
  • Document US 2005/211246 A1 describes a method and device for controlling positive pressure assist to a patient during expiration and teaches comparing a diaphragm electrical activity (EAdi) level with a previously stored lowest EAdi level in view of updating the stored lowest (i.e. a minimum) EAdi level, as a part of a process for controlling a level of positive pressure assist.
  • EAdi diaphragm electrical activity
  • a method for determining dynamically a respiratory feature in a spontaneously breathing patient receiving mechanical ventilatory assist comprises: modifying a level of mechanical ventilatory assist to the patient, measuring an airway pressure, detecting a change of gradient of the measured airway pressure and determining the respiratory feature based on the measured airway pressure upon detecting the change of gradient of the airway pressure.
  • the present invention further relates to a method for determining dynamically a respiratory feature in a spontaneously breathing patient receiving mechanical ventilatory assist.
  • the method comprises: modifying a level of mechanical ventilatory assist to the patient, measuring a respiratory neural drive of the patient, detecting a lowest level of the measured respiratory neural drive and determining the respiratory feature based on the detected lowest level of respiratory neural drive.
  • the present invention is also concerned with a device for determining dynamically a respiratory feature in a spontaneously breathing patient receiving mechanical ventilatory assist.
  • the device comprises: a ventilator for applying mechanical ventilatory assist to the patient, a controller of the ventilator for modifying a level of mechanical ventilatory assist to the patient, an airway pressure detector for measuring an airway pressure and detecting a change of gradient of the measured airway pressure, and a calculator, connected to the airway pressure detector, for determining the respiratory feature based on the airway pressure measured upon detecting the change of gradient of the measured airway pressure.
  • the present invention still further relates to a device for determining a respiratory feature in a spontaneously breathing patient receiving mechanical ventilatory assist.
  • the device comprises: a ventilator for applying mechanical ventilatory assist to the patient, a controller of the ventilator for modifying a level of mechanical ventilatory assist to the patient, a respiratory neural drive detector for measuring a respiratory neural drive and for detecting a lowest level of the measured respiratory neural drive, and a calculator for determining the respiratory feature based on the detected lowest level of respiratory neural drive.
  • this non-restrictive illustrative embodiment according to the present invention also pertains to the measurements of:
  • the transpulmonary pressure P TR which represents the pressure required for distending the lungs, is given by the difference between the airway pressure P aw and pleural pressures, the latter being usually measured through an esophageal balloon (P es ).
  • the lung distending pressure i.e. the gradient of transpulmonary pressure acting to expand the lungs
  • the transpulmonary pressure P TR can be calculated from the difference P aw - P es .
  • the non-restrictive illustrative embodiment of the present invention is based on a progressive increase of ventilatory assist starting from a zero level (or small level) to a high level.
  • the increase of assist is preferably linear but can also be arbitrary or follow a non-linear function.
  • an increase of the proportionality constant ⁇ when/if EAdi remains constant increases the ventilatory assist (i.e. increases the pressure P aw in the respiratory circuit). If EAdi is decreasing when the proportionality constant ⁇ is increased, then the rate at which P aw increases will decrease.
  • Figure 1 illustrates a system 10 according to the non-restrictive illustrative embodiment of the present invention.
  • the system 10 comprises a mechanical ventilator 12, a controller 14, an EAdi level detector 16, a P aw detector 18 and an elastance and resistance calculator 20.
  • the ventilator 12 can be the mechanical ventilator disclosed in US Patent No. 5,820,560 , whose ventilatory assist is controlled as a function of a respiratory neural drive such as EAdi (electrical activity of the diaphragm). Furthermore, the ventilator 12 is connected to the controller 14 for adjusting the degree of assist from the ventilator 12, through the above described proportionality constant ⁇ . By increasing the proportionality constant ⁇ , the degree of ventilatory assist is increased and vice versa if the proportionality constant ⁇ is decreased.
  • the EAdi level detector 16 When ventilatory assist is applied to a patient (not shown), the EAdi level detector 16, which is connected both to the patient and the ventilator 12, detects and records the EAdi level in response to ventilatory assist.
  • the EAdi level detector 16 is further designed to detect a lowest level of EAdi, meaning that it can determine the point where the EAdi level reaches a plateau and the value of this plateau. From this level on, EAdi becomes insensitive to an increase of ventilatory assist, meaning that EAdi is no longer decreasing even though the level of assist may still be increasing. At this level of lowest EAdi, P es is close to zero, therefore P aw - P TR .
  • the P aw detector 18 is connected to the EAdi level detector 16.
  • the P aw detector 18 detects a change in the gradient of the airway pressure P aw supplied by the ventilator 12. When a change in the gradient of P aw is detected, then it means that respiratory unloading has satisfied respiratory centers.
  • the mechanics of the lungs such as elastance and resistance can be calculated by the calculator 20.
  • the proportionality constant ⁇ is set to a small value, in operation 141. It can be set to zero, for example.
  • the proportionality constant ⁇ is then increased by a certain increment by the controller 14 of Figure 1 , or in a linear manner.
  • the value and nature of the increment can depend on many factors such as the health of the patient and the category of the patient (infant, child, adult, etc.).
  • the ventilatory assist also increases to a higher level. Therefore, there is an increase in P aw associated with increasing the proportionality constant ⁇ .
  • the rate of decrease of EAdi has increased so as to reduce the increase of P aw .
  • the level of ventilatory assist satisfies the muscular receptors sensitive to muscle load and pulmonary receptors responsive to lung recruitment/stretch.
  • the point where the rate of increase of P aw (gradient) changes or reaches a plateau can be determined, for example, by visual inspection, or by algorithms for calculating the rate of increase of P aw or by applying trigonometric functions. Such functions can be implemented in the P aw detector 18.
  • the value of P aw and the proportionality constant ⁇ observed at the point where the rate of increase of P aw (gradient) changes or reaches a plateau indicate a level of ventilatory assist that is likely to satisfy the patient's need for respiratory muscle unloading, as determined by the patient respiratory centers. It should be noted that repeated titrations would increase the reliability of the measurements of P aw . Also, if the patient improves his/her respiratory function or capability of breathing by himself/herself, one would expect a lower level of P aw at the point where the rate of increase of P aw (gradient) changes or reaches a plateau and vice versa if the patient's respiratory function is deteriorated.
  • the point where the rate of increase of P aw (gradient) changes or reaches a plateau can also be determined by starting with a high assist/high proportionality constant ⁇ and then reducing the assist/proportionality constant ⁇ until a change of gradient of P aw is observed.
  • This alternative method 150 is illustrated in Figure 3 .
  • the proportionality constant ⁇ is set to a high value. This value can be easily determined by a person of ordinary skill in the art and will depend on parameters such as the health of the patient and the patient's category (infant, child, adult, etc.).
  • the proportionality constant ⁇ is decreased, for example in a linear manner.
  • the current value of P aw is recorded and represents the level of pressure required for respiratory muscle unloading. Also, the current value of the proportionality constant ⁇ is stored and represents the level of the proportionality constant ⁇ that satisfies muscular receptory sensitive to muscle load (muscles no longer need to work).
  • the proportionality constant ⁇ is then increased in operation 104, for example by a given increment or in a linear manner.
  • EAdi decreases as illustrated in the upper curve of Figure 12 .
  • Figure 12 shows an example of EAdi and P aw during titration with a linearly increasing proportionality constant ⁇ starting from zero (0).
  • the airway pressure P aw will increase at a rate determined by the rate of increase of the proportionality constant ⁇ and the EAdi response.
  • the dynamics between these different variables are as follows: EAdi will first remain at a high level or slowly decrease, and P aw will increase at a relatively fast rate. At some point, EAdi will decrease at a more rapid rate, thus slowing the rate of increase in P aw .
  • the EAdi level detector 16 determines if the level of EAdi has reached a plateau or not.
  • the method 100 goes back to operation 104 in order to continue to increase the proportionality constant ⁇ . Indeed, continuing to increase the proportionality constant ⁇ will at some point cause the neural drive EAdi to reach a lowest level of neural drive where it will plateau.
  • EAdi If the level of EAdi has reached a plateau, then in operation 108, a value for P aw is obtained.
  • the point of lowest level of neural drive EAdi most likely represents the point where the respiratory work load is compensated as indicated by the abolished inspiratory P es in Figure 7 . In other words, the pressure required to inflate the lungs is provided via the mechanical ventilator.
  • the lowest level of the neural drive EAdi is determined at the point where EAdi stops to decrease, which is referred to as the lowest EAdi level in the present specification.
  • This lowest EAdi level represents the case where the mechanical ventilatory assist replaces the inspiratory muscles' work to expand the lungs.
  • Figure 7 shows an example of curves corresponding to EAdi flow, volume, P aw and P es at the lowest EAdi level.
  • volume and transpulmonary pressure P TR can be used to determine dynamic elastance of the lungs.
  • An example of curves of the volume in function of P aw is illustrated in Figures 8 and 11 . It should be noted that the same curves as those in Figure 11 can also be obtained for only expiration to determine expiratory mechanics.
  • elastance can be estimated by measuring the inspiratory transpulmonary pressure swing and the corresponding lung volume during an inspiration and then calculate the pressure to volume ratio.
  • Inspiratory resistance can be obtained by calculating a ratio between the inspiratory transpulmonary pressure swing and the flow rate during, for example, mid-inspiratory volume of an inspiration.
  • Another example for calculating lung elastance consists of applying a multiple linear regression analysis using the transpulmonary pressure P TR as the dependent variable and flow and volume as the independent variables; regression coefficients for flow and volume can then be determined.
  • P aw is then similar to the transpulmonary pressure P TR at the lowest EAdi level. Therefore, P aw can be used to calculate the lung mechanics in operation 110.
  • PEEP positive end-expiratory pressure
  • variable determination such as elastance and resistance of the lungs can then be determined for different levels of PEEP, as will be described hereinbelow. Indeed, the lowest level of EAdi and the value of P aw at the point when its gradient changes allow for dynamic measurements.
  • PEEP positive end-expiratory pressure
  • the PEEP level is further increased, the further expansion of the lungs will make the lungs stiffer such that more pressure will be needed to generate a given inspiratory volume, and thus the lungs are less compliant.
  • the elastic and resistive properties of the lungs can be dynamically determined as described above for each level of PEEP applied.
  • the method 119 of Figure 5 starts by applying a PEEP of lower level, for example, through an expiratory valve (not shown), in operation 120, at the level of ventilatory assist (pressure P aw ) representative of the lowest EAdi level found in operation 108 of Figure 4 , by using the corresponding value of the proportionality constant ⁇ .
  • the level of PEEP is increased, for example, linearly, in operation 122.
  • the elastic properties of the lungs are calculated, using methods well known to those of ordinary skill in the art and using the calculator 20 of Figure 1 , for example. This value of the PEEP is recorded.
  • the dynamic resistive properties of the lungs are calculated, using methods well known to those of ordinary skill in the art and using the calculator 20 of Figure 1 , for example. This value of the PEEP is recorded.
  • the method 119 goes back to operation 122 in order to continue to increase, for example, linearly, the level of PEEP to an increased level and then to calculate the dynamic elastic and resistive properties of the lungs (respectively operations 124 and 126).
  • the level of PEEP has already reached the higher level of operation 128, then, in operation 130, it is possible to determine which level of PEEP, among the different increased levels of PEEP, is associated with the least impaired respiratory mechanics by comparing the different calculated values of elastic and resistive properties.
  • comparing elastance and resistance values at various levels of PEEP at the level of ventilatory assist that represents the lowest EAdi level one can determine which PEEP level is associated with the lowest level of elastic and resistive loads.
  • the level of PEEP associated with the lowest elastic and resistive loads is the one that is most likely related to ideal lung recruitment.
  • breathing frequency and tidal volume do normally not change between these points.
  • the method 145 is based on the lowest EAdi level determined in operation 106, in the method 100 of Figure 4 .
  • the method 145 also uses the value of P aw determined in operation 146 of the method 140 of Figure 2 or in operation 158 of the method 150 of Figure 2 when its gradient changes.
  • a level of EAdi corresponding to the point when the gradient of P aw changes is determined, as illustrated in Figure 12 .
  • a difference or ratio is calculated between the lowest level of EAdi and the EAdi level corresponding to a change in gradient of P aw .
  • this difference or ratio allows to express the amount of absolute or relative increase in EAdi contributed by the respiratory mechanical load.
  • the difference or ratio in EAdi can be calculated through a calculator (not shown), for example.
  • EAdi the amount of absolute or relative increase in EAdi allows for quantification of respiratory drive and partition of the respiratory drive into chemical/habitual drive and load related drive.

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Claims (7)

  1. Dispositif (10) pour déterminer dynamiquement une caractéristique respiratoire chez un patient respirant spontanément placé sous assistance ventilatoire mécanique, comprenant un ventilateur (12) pour appliquer une assistance ventilatoire mécanique au patient, et un dispositif de commande (14) du ventilateur (12) pour modifier un niveau d'assistance ventilatoire mécanique au patient;
    un détecteur de pression des voies respiratoires (18) pour mesurer une pression des voies respiratoires (Paw) dans le ventilateur (12) ou dans les voies respiratoires du patient et pour détecter un changement du gradient de la pression des voies respiratoires mesurée (Paw); et
    caractérisé en ce que le dispositif comprend en outre:
    un calculateur (20), connecté au détecteur de pression des voies respiratoires (18), pour déterminer la caractéristique respiratoire sur la base de la pression des voies respiratoires (Paw) mesurée lors de la détection du changement de gradient de la pression des voies respiratoires mesurée (Paw).
  2. Dispositif selon la revendication 1, dans lequel le dispositif de commande (14) est configuré de manière à modifier le niveau d'assistance ventilatoire mécanique au patient en exécutant l'une des opérations suivantes:
    augmenter ledit niveau d'assistance ventilatoire mécanique; et
    diminuer ledit niveau d'assistance ventilatoire mécanique.
  3. Dispositif selon la revendication 1, dans lequel le dispositif de commande (14) est configuré de manière à utiliser une constante de proportionnalité (γ), définie comme étant un rapport entre la pression des voies respiratoires mesurée (Paw) et une commande neurale respiratoire (EAdi), afin de modifier le niveau d'assistance ventilatoire mécanique au patient.
  4. Dispositif selon la revendication 3, dans lequel le dispositif de commande (14) change la constante de proportionnalité (γ) par rapport à une fonction pour modifier le niveau d'assistance ventilatoire mécanique au patient.
  5. Dispositif selon la revendication 4, dans lequel la fonction pour modifier le niveau d'assistance ventilatoire mécanique au patient est sélectionnée parmi une fonction linéaire, une fonction non linéaire et une fonction arbitraire.
  6. Dispositif selon la revendication 1, dans lequel le calculateur (20) utilise la pression des voies respiratoires (Paw) mesurée lors de la détection d'un changement de gradient de la pression des voies respiratoires mesurée (Paw) pour déterminer physiologiquement la décharge du muscle respiratoire.
  7. Dispositif selon la revendication 1, dans lequel le détecteur de pression des voies respiratoires (18) détecte un plateau atteint par la pression des voies respiratoires (Paw).
EP07701707.7A 2006-01-19 2007-01-19 Système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placé sous assistance ventilatoire mécanique Active EP1973470B1 (fr)

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EP17180532.8A EP3245949A1 (fr) 2006-01-19 2007-01-19 Procédé et système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placés sous assistance ventilatoire mécanique

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US75997706P 2006-01-19 2006-01-19
PCT/CA2007/000079 WO2007082384A1 (fr) 2006-01-19 2007-01-19 Procédé et système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placé sous assistance ventilatoire mécanique

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EP1973470A1 EP1973470A1 (fr) 2008-10-01
EP1973470A4 EP1973470A4 (fr) 2010-01-06
EP1973470B1 true EP1973470B1 (fr) 2017-07-12

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EP17180532.8A Pending EP3245949A1 (fr) 2006-01-19 2007-01-19 Procédé et système permettant de déterminer dynamiquement des caractéristiques respiratoires chez des patients respirant spontanément placés sous assistance ventilatoire mécanique

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EP (2) EP1973470B1 (fr)
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Families Citing this family (33)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9050005B2 (en) 2005-08-25 2015-06-09 Synapse Biomedical, Inc. Method and apparatus for transgastric neurostimulation
EP1996284A2 (fr) 2006-03-09 2008-12-03 Synapse Biomedical, Inc. Système d'assistance ventilatoire et procédé servant à améliorer la fonction respiratoire
US9079016B2 (en) 2007-02-05 2015-07-14 Synapse Biomedical, Inc. Removable intramuscular electrode
US9820671B2 (en) 2007-05-17 2017-11-21 Synapse Biomedical, Inc. Devices and methods for assessing motor point electromyogram as a biomarker
US8428726B2 (en) 2007-10-30 2013-04-23 Synapse Biomedical, Inc. Device and method of neuromodulation to effect a functionally restorative adaption of the neuromuscular system
US8478412B2 (en) 2007-10-30 2013-07-02 Synapse Biomedical, Inc. Method of improving sleep disordered breathing
WO2010067244A1 (fr) * 2008-12-10 2010-06-17 Koninklijke Philips Electronics, N.V. Détermination de l'élastance et de la résistance
EP2381992B1 (fr) * 2009-01-15 2019-02-27 St. Michael's Hospital Dispositif de détermination d'un niveau d'assistance ventilatoire à un patient
WO2010081230A1 (fr) * 2009-01-16 2010-07-22 St. Michael's Hospital Méthode et système de mesure de changements dans une charge respiratoire
EP2397074B1 (fr) * 2010-06-19 2012-10-24 M Stenqvist AB Système et support lisible par ordinateur stockant un programme pour déterminer la pression transpulmonaire chez un patient connecté à un appareil respiratoire
EP4112110A1 (fr) * 2010-08-27 2023-01-04 ResMed Pty Ltd Établissement de cycle adaptatif pour un appareil de traitement respiratoire
ITMO20110133A1 (it) * 2011-05-25 2012-11-26 Graziano Azzolini Apparecchiatura per la nutrizione enterale
DE102012215662A1 (de) 2012-09-04 2014-03-06 Hamilton Medical Ag System zur automatisierten Einstellung eines durch eine Beatmungseinrichtung vorgegebenen Drucks
DK3003443T3 (da) * 2013-05-24 2020-03-23 Mermaid Care As System og tilsvarende fremgangsmåde til estimering af respiratorisk drive hos mekanisk ventilerede patienter
US10398630B2 (en) 2014-09-23 2019-09-03 Sidam S.R.L. Appliance for enteral nutrition
SE538864C2 (sv) * 2015-05-25 2017-01-10 The Lung Barometry Sweden AB Method System and Software for Protective Ventilation
CN107921227A (zh) * 2015-08-07 2018-04-17 皇家飞利浦有限公司 心脏、心肺和/或血液动力学表型分析
US10758693B2 (en) 2015-09-10 2020-09-01 St. Michael's Hospital. Method and system for adjusting a level of ventilatory assist to a patient
CN109152898B (zh) * 2015-12-31 2021-06-22 圣米高医院 用于控制通气辅助的装置和方法
WO2018143844A1 (fr) * 2017-02-03 2018-08-09 Maquet Critical Care Ab Détermination de l'efficacité neuromusculaire durant une ventilation artificielle
EP3585465B1 (fr) * 2017-02-22 2023-07-05 Koninklijke Philips N.V. Sélection automatique de pep pour la ventilation mécanique
CN110049799B (zh) 2017-11-14 2022-04-26 柯惠有限合伙公司 用于驱动压力自发通气的方法和系统
US20190231202A1 (en) * 2018-01-31 2019-08-01 Loewenstein Medical Technology S.A. System for recording the breathing efforts of a patient
EP3773839B1 (fr) 2018-10-17 2022-05-25 Maquet Critical Care AB Mobilisation pulmonaire dans une ventilation mécanique
US20210213221A1 (en) * 2018-10-17 2021-07-15 Maquet Critical Care Ab Lung recruitment in mechanical ventilation
WO2020080983A1 (fr) * 2018-10-17 2020-04-23 Maquet Critical Care Ab Mobilisation pulmonaire dans une ventilation mécanique
EP3773835B1 (fr) * 2018-10-17 2022-05-18 Maquet Critical Care AB Recrutement pulmonaire dans une ventilation mécanique
WO2020080985A1 (fr) * 2018-10-17 2020-04-23 Maquet Critical Care Ab Recrutement pulmonaire dans une ventilation mécanique
CN113226421A (zh) * 2018-12-24 2021-08-06 皇家飞利浦有限公司 压力支持系统以及向患者提供压力支持治疗的方法
DE102019000584A1 (de) * 2019-01-29 2020-07-30 Drägerwerk AG & Co. KGaA Beatmungsvorrichtung und Beatmungsverfahren
US11471683B2 (en) 2019-01-29 2022-10-18 Synapse Biomedical, Inc. Systems and methods for treating sleep apnea using neuromodulation
EP4070840A4 (fr) * 2019-12-03 2022-12-14 Shenzhen Mindray Bio-Medical Electronics Co., Ltd. Appareil de surveillance de ventilation de patient et procédé de surveillance de ventilation associé
US20230113361A1 (en) * 2020-03-09 2023-04-13 Christer Sinderby Method and system for controlling a level of ventilatory assist applied to a patient by a mechanical ventilator

Family Cites Families (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1103279A3 (fr) * 1990-03-30 2001-06-27 The University Of Manitoba Respirateur artificiel
JP2582010B2 (ja) * 1991-07-05 1997-02-19 芳嗣 山田 呼吸筋活動のモニタ装置
US5535738A (en) * 1994-06-03 1996-07-16 Respironics, Inc. Method and apparatus for providing proportional positive airway pressure to treat sleep disordered breathing
US5671752A (en) * 1995-03-31 1997-09-30 Universite De Montreal/The Royal Insitution For The Advancement Of Learning (Mcgill University) Diaphragm electromyography analysis method and system
US5820560A (en) 1995-03-31 1998-10-13 Universite De Montreal Inspiratory proportional pressure assist ventilation controlled by a diaphragm electromyographic signal
GB9525994D0 (en) * 1995-12-20 1996-02-21 Univ Manitoba Improvements in delivery of assist modes of mechanical ventilation
US5884622A (en) * 1996-12-20 1999-03-23 University Of Manitoba Automatic determination of passive elastic and resistive properties of the respiratory system during assisted mechanical ventilation
US6015388A (en) * 1997-03-17 2000-01-18 Nims, Inc. Method for analyzing breath waveforms as to their neuromuscular respiratory implications
US5937854A (en) 1998-01-06 1999-08-17 Sensormedics Corporation Ventilator pressure optimization method and apparatus
US6588423B1 (en) * 1998-02-27 2003-07-08 Universite De Montreal Method and device responsive to myoelectrical activity for triggering ventilatory support
US6257234B1 (en) * 1998-08-21 2001-07-10 Respironics, Inc. Apparatus and method for determining respiratory mechanics of a patient and for controlling a ventilator based thereon
US6962155B1 (en) * 1999-07-30 2005-11-08 Universite De Montreal Target drive ventilation gain controller and method
SE0103182D0 (sv) 2001-09-25 2001-09-25 Siemens Elema Ab Förfarande för lungmekanisk undersökning och andningsapparatsystem
BRPI0313823B8 (pt) * 2002-08-30 2021-06-22 Univ Florida método e aparelho para predizer o trabalho da respiração
US7588033B2 (en) * 2003-06-18 2009-09-15 Breathe Technologies, Inc. Methods, systems and devices for improving ventilation in a lung area
US8256419B2 (en) 2004-02-18 2012-09-04 Maquet Critical Care Ab Method and device using myoelectrical activity for optimizing a patient's ventilatory assist
US7472702B2 (en) * 2004-03-25 2009-01-06 Maquet Critical Care Ab Method and device responsive to diaphragmatic activity for adjusting positive pressure assist during expiration
EP1727464B1 (fr) 2004-03-25 2008-01-23 Olympus Corporation Appareil et systeme d'appareil d'acquisition d'informations in-vivo
EP1765442B1 (fr) * 2004-06-24 2017-08-02 Convergent Engineering, Inc. APPAREIL DESTINE A LA PREDICTION NON INVASIVE DE PRESSION POSITIVE EN FIN D'EXPIRATION (PEEPi) CHEZ DES PATIENTS SOUS ASSISTANCE RESPIRATOIRE

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Publication number Publication date
US8551009B2 (en) 2013-10-08
US20100228142A1 (en) 2010-09-09
WO2007082384A1 (fr) 2007-07-26
EP3245949A1 (fr) 2017-11-22
JP5264506B2 (ja) 2013-08-14
EP1973470A4 (fr) 2010-01-06
JP2009523505A (ja) 2009-06-25
EP1973470A1 (fr) 2008-10-01

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